PMS and PMDD symptoms

Natural Treatment of PMS and PMDD

Raise your hand if you struggle with menstrual cramps, painful periods, irritability, mood swings, depression, and more the days and weeks leading up to your period. 

If you raised your hand, you are not alone! 

Nearly 90% of all menstruating women in the United States experience premenstrual syndrome (PMS) in their lifetime. And approximately 3% of those women experience such severe symptoms that they can be categorized as having premenstrual dysphoric disorder (PMDD).

Contrary to what some people may think, PMS and PMDD are real conditions. They can cause significant physical discomfort, impact your mental and emotional health, and disrupt your daily life.

Below, we’ll review the symptoms, causes of PMS and PMDD and how to naturally treat them. 

 

What are PMS and PMDD?

PMS is a group of symptoms that many women experience during the luteal phase of their menstrual cycle. Typically starting around ovulation and ending the first day of their period. 

PMDD, on the other hand, is a type of PMS but the symptoms are much more severe. Women who suffer from PMDD experience a decreased response to the body’s inhibitory molecule, GABA, which helps to limit activity associated with stress and anxiety. Causing women to experience five or more common PMS symptoms for seven or more days.

 

PMS and PMDD Symptoms

PMS can begin a few days or up to two weeks before the start of a woman’s period with mild to moderate symptoms. These symptoms only occur within those two weeks and are not present during the rest of the month. 

PMS can present with a variety of physical, emotional, and cognitive symptoms including:

  • Bloating
  • Headache
  • Fatigue
  • Acne flare-ups
  • Breast tenderness
  • Mood swings
  • Depression or anxiety
  • Changes in appetite
  • Insomnia
  • Constipation or diarrhea

PMDD shares many of the same symptoms as PMS, but these symptoms are much more severe. These symptoms can be so severe that they disrupt tasks of daily living. And, many women experience very little relief from common over-the-counter medications.

 

What Causes PMS and PMDD?

Scientific research hasn’t conclusively identified the cause of PMS or PMDD. Nor has it determined why some women experience it more severely than others. But, research has suggested several different theories as to what causes PMS and PMDD.

 

Hormonal changes that occur during the menstrual cycle:

Many believe that PMS occurs in response to the changing levels of the hormones estrogen and progesterone. Also referred to as the sex hormones. 

These hormonal fluctuations are thought to increase anxiety, irritability, and other mood changes experienced before your period.

 

Interaction between sex hormones and neurotransmitters:

The fluctuating levels of the sex hormones can impact the brain chemicals serotonin, dopamine, and GABA. Estrogen is required to synthesize serotonin and increases the number of serotonin receptors in the brain. Whereas progesterone helps stimulate dopamine release and increase GABA function.

Because both estrogen and progesterone levels drop before your period, the production and the effect of these “feel-good” chemicals are impacted. Leading to increased anxiety, changes in mood, and insomnia.

In women who struggle with PMDD, progesterone alters the shape of their GABA receptors making it harder for GABA to bind to them and improve mood, depression, or anxiety.

 

Other contributing factors:

There are other contributing factors that could lead to both PMS and PMDD including:

  • Genetics – There are hundreds of genes that help eliminate toxins from our bodies. One example is the COMT gene which helps to eliminate estrogen from your body. Those with the slow COMT gene mutation struggle to eliminate excess estrogen and can experience endometriosis, strong PMS, and fibroids to name a few.
  • Weight – No matter the cause for being overweight, an increase in fatty tissue equals an increase in hormones. Increased production of estrogen can cause inflammatory responses in the body and promote many PMS symptoms.
  • Estrogen Dominance – If the gut is not processing estrogen or the liver is unable to detox estrogen, the body will have an increased level of estrogen relative to progesterone. 
  • Detox Issues – If the liver is unable to detox excess estrogen it may be too stressed and require you to decrease your toxin load in other ways.
  • Gut Health – Our intestines are filled with trillions of bacterial cells (known as the microbiome) that work together to regulate the production, metabolism, and detoxification of hormones. When the microbiome is disturbed and the bacteria is damaged, dysbiosis can occur. Learn more about the importance of gut health and hormones here.
  • Histamine Intolerance – How your body reacts to the foods you eat can be driven by hormone fluctuations. Estrogen dominance can increase histamine and adequate progesterone can help balance it out.

Diagnosing PMS and PMDD

There is no definitive test to diagnose PMS or PMDD. However, there are several screening tools I used when diagnosing PMS and PMDD. 

  • Estrogen and Progesterone – DUTCH test or a serum blood test done seven days post ovulation to evaluate your estrogen and progesterone levels. 
  • Adrenal Testing – DUTCH test to evaluate your adrenal health and confirm you are not experiencing an HPA axis dysregulation
  • Thyroid – You need adequate amounts of thyroid hormones for your ovaries to make progesterone. Progesterone also helps the thyroid function well. Research has reported that a high percentage of women with PMS also have hypothyroidism.
  • Blood Glucose and Insulin Sensitivity – High blood sugar levels lead to high insulin levels which decreases the sex hormone-binding globulin (SHBG). If your insulin is always high there won’t be much SHBG causing estrogen and testosterone to rise relative to progesterone. 

Natural Treatment of PMS and PMDD

If you have PMS or PMDD, there are several natural treatments that I use to relieve symptoms. These can include strategies such as diet modifications, exercise, and supplements. All focused on improving your overall well-being, stress relief, and symptom management.

Here are some of my more commonly used natural treatments for PMS and PMDD.

Diet

Eating healthy is critical to managing PMS and PMDD. Some foods can increase the likelihood of some symptoms like bloating, blood sugar fluctuations, fatigue, and mood swings. I recommend:

  • Omit refined sugar, carbs, caffeine, and alcohol.
  • Choose grass-fed, wild, and organic foods when possible. 
  • Boost your veggie intake! Load up on cruciferous veggies and fruits high in antioxidants like broccoli, cauliflower, brussels, kale, and arugula.
  • Increase your fiber during the luteal phase of your cycle. 
  • Add 2 TBSP of ground flaxseed to your diet daily

Exercise

Move your body daily! Several research studies have shown that moderate cardio exercise everyday can help improve PMS and PMDD symptoms in four to eight weeks! 

Aim for 30 to 40 minutes per day of cardio exercise or yoga. 

Supplements

Getting the required dietary supplements each day has been shown to improve PMS and PMDD symptoms. Depending upon your symptoms and dietary requirements I recommend the following supplements:

  • Magnesium: Migraine headaches, anxiety, adrenal concerns, blood pressure issues…your magnesium is likely lacking. Think of it as a calming agent that you can use just about anytime. 
  • Vitamin B6: Helps to produce progesterone and promote GABA synthesis which can ease fatigue, irritability, and insomnia. I recommend beginning with 50 mg. 
  • Vitamin E and good fats. Vitamin E supplements and essential fatty acids help combat the effects of PMS by reducing the effects of the hormone prolactin. I suggest starting with 800 iu Vitamin E Tocotrienols, 2 caps of omegaMonoPure 1300 [email office for more information on this product], or 2 caps of EPO (bonus: EPO is great for glowing skin!).  
  • Calcium: Adding additional calcium support has shown to be a simple and effective treatment for the luteal phase symptoms of PMS. I recommend adding 1200 mg of calcium per day.
  • Saffron: In women with mild to moderate depression, saffron has shown to have an antidepressant-like effect. And, it can be used throughout the luteal phase of your cycle. I used the product MoodStasis beginning with 15 mg twice a day.
  • Progesterone Drops. Augmenting your progesterone with natural progesterone drops based on your labs can help mimic your body’s progesterone production. This cyclic taper allows us to taper up or down based on your personal need. (email our office for help with this product)
  • Hormone-balancing herbal blends. A hormone-balancing herbal blend can help promote progesterone production and estrogen clearance. I often use Vitex, DIM, or CDG to promote progesterone production. I use Calcium d-Glutarate to help prevent estrogen metabolites from recirculating back into the bloodstream from the gut and to help eliminate excessive estrogen. And there are many classical Chinese herbal formulas specific to women’s health and hormones that I will often incorporate based on your constitution and symptom presentation. 

Liver Detox

If the liver has to work hard to filter out harmful toxins from the body, its capacity to cleanse the blood from estrogen can be compromised. In addition to decreasing your overall toxic load, eliminating alcohol can help improve your liver’s ability to detox excess estrogen. Alcohol increases allopregnanolone (a neurosteroid made from progesterone) which can reduce the effectiveness of GABA. Ultimately increasing symptoms of PMS and PMDD.

Say Goodbye to PMS and PMDD Naturally 

The bottom line is…if your PMS symptoms occur month after month and affect your quality of life, it’s time to get some help! You don’t need to live with physical discomfort, mood swings, anxiety, or depression. 

Based on your symptoms and lab results, we will develop a personalized treatment plan to help you say goodbye to PMS and PMDD! 

Are you ready to say goodbye to PMS? Begin by scheduling a free 15-minute troubleshooting call


Anxiety Disorder

Anxiety Disorder Symptoms, Hormonal Imbalance, and Histamine Intolerance: The Surprising Connection

Your brain is foggy. Making even small decisions feels overwhelming. 

You’re worried about everything and it’s hard to sleep at night. 

The fatigue that nearly overpowers you makes you want to go back to bed and pull the covers over your head and hide from everyone and everything.

You’re cranky, restless, and on edge. Panic attacks cause your heart to race and your palms to get sweaty. 

Even if you only have only a couple of these problems, you may have generalized anxiety disorder.  That’s the bad news. 

The good news? You can feel at peace, happy, and calm again. The answer lies in balancing your hormones. But that’s not all. You’ll also need to get rid of problems like blood sugar imbalance that cause your hormones to get out of whack. Then there’s histamine intolerance, which is strongly linked to hormonal imbalances and anxiety.

 

Hormone Imbalance: The Victim Not the Villain 

Imbalanced hormones are not the villains responsible for your anxiety disorder. They’re more like the victims of other problems happening in your body. That’s why as a functional medicine provider specializing in irritable bowel syndrome, inflammatory bowel disease, and women’s fertility issues I see a lot of patients who also suffer from anxiety and panic attacks.  

In fact, 75% of my patients present to my clinic with anxiety along with other issues like acid reflux, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), digestive issues, endometriosis and many more. 

Hormones are actually responders, the language the body uses to talk to itself. Hormones express what they’re seeing in the different tissues around your body and tell your body how best to respond. 

In other words, when hormones break, it’s not typically the root cause of your problems. Rather, the hormones shift in response to the root cause or causes of your health problems. 

That said, working to adjust and balance hormones  can help you feel better. When your hormones are balanced, you will have more energy and bandwidth to work on the real root cause underlying your health problems.

In this article, I’m going to dive into one common factor that breaks hormonal balance. Then I’ll hone in on one of the most important hormones for people suffering from anxiety disorder and its link to histamine intolerance. 

I’ll also shed light on some of the other reasons for anxiety and panic attacks and let you know what you can do to feel less anxious and more at peace. 

First, though, let’s talk about what generalized anxiety disorder actually is and its symptoms.

 

What Is Generalized Anxiety Disorder?

Everyone gets anxious from time to time. Work deadlines, tests at school, dealing with relationship problems or other stressors can all lead to occasional anxiety. 

People with generalized anxiety disorder, on the other hand, experience ongoing worry or fear much of the time. 

Often, people with anxiety disorder feel anxious or get panic attacks even while trying to make simple decisions. Generalized anxiety disorder can cause problems at work, in school, and in your relationships.     

Symptoms of generalized anxiety disorder include :

  • Difficulty concentrating or brain fog
  • Fatigue
  • Insomnia (difficulty falling or staying asleep)
  • Irritability
  • Restlessness
  • Worry

Generalized anxiety disorder and panic disorder are some of the most common mental disorders in the United States. These are different types of anxiety disorders. Technically, conventional medicine considers panic attacks to be a separate disorder. However, in my experience as a functional medicine provider, most people aren’t going to have panic attacks without already having generalized anxiety disorder. 

Symptoms of panic attacks include:

  • Feeling out of control
  • Feelings of impending doom
  • Pounding heartbeat or rapid heart rate
  • Shortness of breath, smothering, or choking
  • Sweating
  • Trembling

Past trauma can trigger panic attacks. But they can also happen in people who have never experienced any trauma. 

 

Blood Sugar Imbalances Wreak Havoc on Hormones

One of the most common reasons why hormones break is because your blood sugar isn’t balanced. I have seen many patients get 90% better just by balancing their blood sugar.

Low blood sugar mimics anxiety. When your blood sugar crashes, the body attempts to push up blood glucose levels. It does this by making epinephrine, otherwise known as adrenaline, which triggers glucose production in the liver. 

Increased adrenaline leads to a “fight-or-flight” stress response in the body. This same biochemical process is also linked to anxiety. 

If you tumble into a chronic, on-going low blood sugar state, your body may boost its production of the stress hormone cortisol. This helps tissues in the body be less reactive to insulin, which boosts glucose circulation in the bloodstream. But high levels of cortisol can cause problems, too.

Guess what higher cortisol levels are also linked to? Anxiety. 

What’s more, in my work with thousands of patients, blood sugar swings have been the biggest driver of fatigue, anxiety, and mood swings!

A functional medicine provider can order the right tests for blood glucose and insulin sensitivity. These include LDH (lactate dehydrogenase), HbA1c (hemoglobin A1c), SHBG (sex hormone binding globulin), fasting glucose, fasting insulin, and sometimes glucose response testing.

To resolve low blood sugar problems that show up on the tests, eat more healthy fats, which are easier to assimilate and digest. 

High quality protein is also important. Back before I knew I had polycystic ovary syndrome – a condition linked to insulin resistance – I was eating vegan and vegetarian and chowing down on carbs. This was the wrong approach because anytime you have a problem with blood sugar or insulin, carbs are the bad guys.

 

The Soothing Effects of Progesterone 

Your brain has receptors for sex hormones like progesterone. So it’s not surprising that progesterone can influence brain function and mood. 

If you have anxiety, progesterone is one of your best friends.

Women with low progesterone levels are prone to anxiety. That’s why in conditions of low progesterone such as during PMS, post-childbirth, perimenopause, and menopause there’s an increase in anxiety and frequency of panic attacks.  

Progesterone and its metabolite allopregnanolone act as a natural antidepressant, enhance mood, and relieve anxiety. Progesterone has a calming effect on the brain. It increases the actions of a feel-good, calming neurotransmitter known as GABA (gamma-aminobutyric acid).

By giving GABA a helping hand, progesterone acts like a hormonal lullaby, helping you fall asleep easier and stay asleep longer. 

 

What’s Histamine Intolerance Got to Do With It?

Histamine is a chemical released by some cells of the body. If you’ve ever had an allergic reaction or seasonal allergies, you’re likely familiar with its effects such as runny rose, sneezing, or hives. 

Histamine isn’t always the bad guy. We need some histamine to release stomach acid and to help move food through the gut. The important thing is for histamine to complete its life cycle by being broken down and cleared from the body. 

When that doesn’t happen histamine intolerance occurs. This is when the body makes too much histamine and too little of the diamine oxidase (DAO) enzyme needed to break it down.

Anxiety is a symptom of histamine intolerance. Other symptoms include headaches, fatigue, nausea, irregular menstrual cycles, sinus issues, digestive problems, tissue swelling, and dizziness. 

In my experience, people most likely to suffer from histamine intolerance are people who are perfectionists. These are often the same people who suffer from anxiety and panic attacks. They want things to be a certain way and hold high expectations. 

Characteristics of people most likely to develop histamine intolerance include:

  • Academic overachievers 
  • Highly motivated 
  • Inner anxiety with a calm exterior
  • Being competitive – with themselves and/or others
  • Having obsessive/compulsive or ritualistic behaviors, or a need for structure and strong routine, feeling of order and control over things.

The above characteristics can actually be positive and work in your favor. If you have those characteristics you’re highly intelligent, super productive, and probably are successful in work and life. When your hormones are in balance these traits can work for you. 

However, if your histamine is too high and your hormones are out of balance then you might develop poor stress tolerance, feelings of anxiety, and insomnia.  

 

Progesterone Guards Against Histamine Intolerance

Progesterone enhances DAO,  the enzyme that breaks down histamine. So progesterone helps histamine meet its maker and clear it from the body. 

Estrogen dominance, on the other hand, boosts the body’s production of histamine. Women whose histamine production is estrogen driven will see flares of their problems either right before ovulation or more likely right before their period, because that’s when they’re naturally estrogen dominant. 

Does anything else cause histamine intolerance besides estrogen dominance? You bet. Genetics can play a role. My own histamine intolerance was partly caused by genetics. But the gut plays a huge role, too. For me, my high histamine and hormonal imbalance came down to the “bad” organisms in my digestive tract (Helicobacter pylori, Giardia, and Candida albicans

Leaky gut leads to lower levels of DAO and in turn high histamine. This is because the place where your body makes DAO is mostly mucosal barriers like the intestines. 

If your liver isn’t working its best, that will cause problems, too. The liver detoxifies histamine. If its detox abilities are weakened, histamine will build up in the body. It’s just one more thing to fill your bucket up to the point of overflowing.  

 

Other Hormones to Watch in Anxiety and Panic

In my patients with anxiety, I always keep an eye on other hormones besides progesterone. These include:

  • Thyroid – If thyroid hormone levels are up and down like in Hashimoto’s it can mimic bipolar disorder. Low thyroid hormones are also linked to low progesterone.
  • DHEA (Dehydroepiandrosterone) – DHEA is the most abundant circulating hormone. Balancing levels of DHEA can lead to better mood and less anxiety. 
  • Serotonin/Estrogen – Serotonin makes you feel content, happy, calm, and ready for sleep. It reduces anxiety and the tendency to think about sad or dark thoughts over and over (cyclical thinking or ruminating). You need estrogen to convert amino acids into serotonin.   
  • Cortisol – Cortisol is primarily produced by the adrenal glands. Adrenal fatigue can make you less likely to cope with stress. If you have a poor stress response, cortisol can be too high or too low. If cortisol goes up due to stress, your progesterone levels can take a tumble. 

 

Strategies to Reduce Anxiety and Panic Attacks

Here are some simple changes you can make to feel calmer and less anxious:

  • Reset your inner clock. First thing in the morning, immerse yourself in bright outdoor sunlight without wearing sunglasses. After sundown, expose yourself to dim light. If you’re not doing these things, neither dietary supplements nor hormone replacement therapy will work.  
  • Let go of toxic people, habits, and behaviors
  • Seek professional therapy
  • Practice stress management techniques like transcendental meditation, hypnotherapy, somatic therapy, nature immersion, the Gupta Program, and psychedelic journeying

 

Natural Hormone Replacement and Dietary Supplements for Stress 

Natural Progesterone - Please email office to discuss

A functional medicine provider can prescribe personalized, low-dose bioidentical progesterone.  This can relieve symptoms of histamine intolerance and estrogen dominance.  

Vitamin B6

Vitamin B6 supplements can help with histamine balance including PMS related to histamine. Vitamin B6 can:

  • Help produce progesterone.
  • Promote GABA synthesis.
  • Convert L-tyrosine and 5-hydroxytryptophan (5-HTP) to dopamine and serotonin, respectively.
  • Enhance DAO production and lower histamine.

Start with 50 mg of vitamin B6 in the form of P5P. You can take more under the guidance of a functional medicine provider. 

Magnesium

Magnesium is a natural stress reliever. I prefer the chelated form of glycinate and the product Neuro-Mag.

L-Theanine, Passionflower

L-theanine, a substance found naturally in green tea, produces calming brain waves. Passionflower (Passiflora incarnata) also has soothing effects.  

Taurine

Taurine is an amino acid that promotes formation and release of GABA, which quiets down  excitatory signals in the brain. A typical dose is 250 mg – 1,000 mg/day. 

Glycine

Best for acute panic attacks rather than chronic anxiety, glycine is an amino acid that interferes with the release of the neurotransmitter norepinephrine. At the first sign of a panic attack, place two grams of glycine powder under the tongue and let it slowly dissolve. This process can be repeated every few minutes if necessary and, in most cases, the problem will resolve within 10 to 15 minutes. 

Cannabidiol (CBD)

This phytocannabinoid has calming, soothing effects. In human studies, CBD reduced anxiety caused by a public speaking test in subjects with social anxiety disorder.  

Lavela

This lavender-derived substance (also known as Silexan™) promotes relaxation and calms nervousness. 

 

I Can Help Balance Hormones and Relieve Anxiety 

To find out whether the root cause of your anxiety disorder and panic attacks is blood sugar issues, low progesterone, or problems with other hormones, you’re going to need an experienced functional medicine practitioner. The first step is to book a free 15-minute troubleshooting call with me. 

If after the call you come on board as a patient, I’ll order the best tests for you and develop a treatment plan based on your unique biochemistry. You will find out the steps you need to take to feel calmer and happier. I know anxiety isn’t easy but together we’ll find a solution to make your life easier.


SIBO

How to Prevent SIBO (Small Intestinal Bacterial Overgrowth) Relapse

You have SIBO (Small Intestinal Bacterial Overgrowth) and you completed all the necessary steps in the “kill phase” of treatment. You run a follow-up breath test and your gas levels have normalized! Or, you didn’t retest, but your symptoms are 90% better! This is great progress and it feels like you are finally moving forward!

But, if you’re just killing the bacteria – you’re only halfway there!!

Many SIBO patients get their initial SIBO treatments and feel good for a while. But then, all the bloating, gas, cramping, constipation, or diarrhea begin to make a very unwelcome comeback. For various reasons, too much bacteria will once again start colonizing the wrong part of the GI tract leading to SIBO relapse. 

Unfortunately, it’s common to have SIBO relapse. But, don’t get discouraged. You’re not wading through the murky waters of SIBO treatment alone.   

Let’s break down if your symptoms are IBS or SIBO, why SIBO relapse might happen, what you can do, and how to help prevent a relapse in the first place.

 

Are my symptoms IBS or SIBO?

When it comes to gut issues, it can be difficult to identify and understand your symptoms. In general, there are two common conditions of the intestines that can present very similarly: Irritable Bowel Syndrome (IBS) and SIBO.

IBS is a functional gastrointestinal disorder. It affects the two-way communication between your digestive system and your brain. When this communication system malfunctions it can throw off your entire digestive tract. Leading to symptoms like abdominal pain, bloating, and altered bowel habits such as constipation or diarrhea. Sounds a lot like SIBO, doesn’t it?

A single underlying cause of IBS has not been identified. But honestly, there are many factors that could lead to IBS including food sensitivities, severe infections, stress, or intestinal muscle issues. What’s interesting is that up to 78% of patients diagnosed with IBS have SIBO.

IBS and SIBO are complex conditions. But, since these conditions can present so similarly it’s important to rule out SIBO with a breath test so that we can customize your treatment plan.

 

What causes SIBO relapse?

I know what you’re asking…if I’ve done the work to identify the cause of SIBO and the SIBO treatment…why on earth is my SIBO coming back?! 

Unfortunately, approximately 45 percent of all SIBO patients will experience a SIBO relapse. There are three primary reasons that my patients experience SIBO relapse: diet, underlying gut conditions, and medications.

Diet

Let’s call it like it is, diet changes are never a quick fix, they are a lifestyle change. A diet that is high in sugar, refined carbohydrates, FODMAP vegetables, or alcohol can make SIBO symptoms like gas, bloating, constipation or diarrhea worsen or relapse. It’s important to introduce foods like starchy veggies in the long run because it feeds the good gut flora. But introducing too much too soon is when you run into issues. 

Underlying Gut Conditions

A physical obstruction in the gut can be both a cause of SIBO and subsequently the cause of SIBO relapse. Crohn’s disease, celiac, diabetes, and leaky gut are the four most common gut conditions that can cause SIBO. 

Medications

Some medications may help with certain issues while wreaking havoc on others. Medications like antibiotics, antihistamines, NSAIDs, acid-blocking drugs (PPIs), and steroids all disrupt your normal gut flora. Some kill healthy bacteria and others increase the permeability of your gut. But, they all increase your chance of SIBO relapse.

 

How To Prevent SIBO Relapse

Preventing SIBO relapse starts during the “kill” phase of your SIBO treatment. There’s a lot you can be doing during and after SIBO treatment to prevent SIBO relapse. Here are a few things I like to include in SIBO treatment plans:  

  1. Address Low Stomach Acid and Pancreatic Digestive Enzymes – These antimicrobial enzymes help enhance nutrient absorption and assimilation.
  2. Support your Oral Microbiome – 94 percent of Americans have some levels of gingivitis or bacteria in their oral cavities that can impact gut health. I recommend Blocidin toothpaste and dental rinse. Plus, don’t forget about flossing. Sorry, no water picks.
  3. Liver Support – The toxins from SIBO have inundated your liver. The endotoxins (the toxic substances bound to bacterial cell walls) from having SIBO saturate the bile and add to your total liver toxic burden. These systems need their own love to get back up to speed. Resolving the excess gram-negative bacteria is the first step. My favorite for bile support is MegaGuard by Microbiome Labs.  Learn more about bile support and gut health.
  4. Repair Leaky Gut/Mucosal Inflammation and Damage – SIBO has likely led to an inflamed gut and has damaged the cellular walls and lining. Not only do you need to kill off harmful bacteria and rebuild healthy gut flora, but you also need to repair any structural damage. I recommend Super Curcumin by Apex, with either MegaMucosa by Microbiome Labs, or GI Balance by Xymogen.

 

What To Do After You’ve Cleared the Bacteria Causing SIBO

The first phase of SIBO treatment is tough and you’ve survived it. Congratulations! But now what? 

Great question! There is a lot you can do after SIBO treatment to prevent relapse and stay healthy. 

  1. Stay on a modified low FODMAP or SIBO Biphasic. To allow your microbiome to heal, I recommend following one of these diets for two to three months, followed by gradual reintroduction of foods that you have omitted.
  2. Add a Prokinetic to address gastroparesis and support the Migrating Motor Complex (MMC). Gastroparesis slows your stomach’s motility preventing it from emptying properly. MMC sweeps residual bacteria and leftover carbohydrates and protein particles out of the small intestine. Waiting 4 hours between meals allows MMC to work because it is only triggered during a fasted state. So, if we snack all the time or chug large amounts of liquid, we’re inhibiting the MMC housekeeping wave. Limit snacks and sip, don’t chug, your fluids. So remember, eat, stop, eat.
  3. Restore your vagal tone and your MMC by retraining your nervous system signaling.  All of the approaches to restoring vagal tone for improved digestion focus on promoting your parasympathetic nervous system activity, over your sympathetic activity. The parasympathetic nervous system helps restore the body to a calm and composed state and prevents it from overworking. Sympathetic activity, on the other hand, prepares the body for a stress-related activity. Depending on what may be causing your sympathetic activity several techniques can be personalized based on your symptoms. This includes vagal nerve stimulation, gut-focused hypnotherapy, Frequency Specific Microcurrent, acupuncture, or the Gupta Program. And, if there has been a big stress or trauma other treatments like EMDR can be considered. Check out inaura.com to identify additional personalized therapy options.
  4. Add single-strain probiotics and prebiotics to your daily routine. Probiotics and prebiotics, added slowly to your diet, can help to rebuild and maintain your healthy gut flora. Because multi-strain probiotic blends are not generally tolerated by SIBO patients I recommend several single strain options based upon your specific symptoms and tendencies (i.e. bloating, constipation, diarrhea, histamine intolerance, etc.). I personalize your routine with some of my favorites including HU 58 (Microbiome Labs), BioGaia Protectis, probiomax by Xymogen, and Ideal Bowel Support (L Planetarium 299V). I start all my patients on a partial dose and work up to help bulk the stool without triggering SIBO. Once you are tolerating partial doses, we can reintroduce most FODMAP foods along with other strains of probiotics for continued gut repair. The key is going slow and steady. Adding any probiotics too soon or too quickly can flare SIBO.

To get you started, let’s focus on diet, probiotics, and prebiotics.

 

SIBO Treatment: Low FODMAP Diet and SIBO Biphasic Diet

Many of my SIBO patients hit the internet and find a lot of information on the “SIBO diet”. The SIBO diet is also known as a low FODMAP diet. 

I recommend following a low FODMAP diet during SIBO treatment and for a short time after. But, in the long haul, a low FODMAP diet can be too restrictive. It does not offer you the necessary food diversity required for a robust and diverse microbiome. But, after the initial treatment, you can slowly reintroduce foods that will support your gut health and regularity.

Some patients also have a lot of success with a SIBO biphasic diet. This diet plan is as restrictive as the low FODMAP diet to start. But, it slowly reintroduces the most tolerated and least fermentable foods back in overtime. The foods eliminated don't change on the biphasic diet. Instead, it provides more guidance on what foods to reintroduce and when.

In reality, diet does not cause SIBO. Period. Diet can cause many other things like candida and poor microbiome health, but SIBO isn’t caused by diet. Instead, a highly-processed, low-quality diet tends to lead to increased symptoms and SIBO relapse. Diet is simply a way to manage your SIBO symptoms during the kill phase and long-term. And, it’s unique to each patient. Whether you follow a low FODMAP or biphasic diet, your SIBO treatment should include a full evaluation of your diet to help manage and control your symptoms. 

 

Benefits of Probiotics and Prebiotics

I know it sounds strange, but utilizing probiotic and prebiotic supplements in the treatment of SIBO can be beneficial. It seems counter-intuitive. If excess bacteria in the small intestine cause SIBO, why would you want to add more?

Probiotics help to reduce bacterial overgrowth and hydrogen concentrations. And, probiotic supplements can help improve symptoms and restore a healthy gut microbiome. Which in turn increases your resilience against SIBO or general dysbiosis by promoting healthy expression of gut immunity and maintaining a strong and resilient mucosal membrane. 

Prebiotic supplements, on the other hand, essentially provide the nutrients needed for healthy bacteria to flourish in your gut. 

Ongoing research shows that probiotic and prebiotic supplements can be very effective in the treatment of SIBO. They can help improve symptoms, improve lab values, and support long-term gut restoration. Yet, not all probiotics and prebiotics are equal. It’s important to introduce the right supplements to focus on helping resolve your specific issues slowly and only as tolerated. Too much, or the wrong things can lead to SIBO relapse if the body isn’t ready. Generally, I start with PHGG (Partially Hydrolyzed Guar Gum) and Acacia.

 

Get Help With SIBO Relapse

SIBO is an incredibly complex condition that requires a great deal of time and energy to resolve. 

Every case of SIBO requires personalized treatment. And as your health guide, we're here to put the pieces of your puzzle together and get you back on track. You deserve to live your life freely and feel well every day!

So, if you find yourself feeling defeated in your journey to better gut health, we are here to help!

Start by scheduling a no-cost, no-obligation 15-minute consultation call to regain control of your health.

 

References

"Probiotics for Preventing and Treating Small Intestinal Bacterial ...." https://pubmed.ncbi.nlm.nih.gov/28267052/. Accessed 10 Feb. 2022.